Why you should buy health insurance through an agent

I get a lot of calls from self-employed people that simply have no idea how to start finding the right health insurance. They might call with questions about what they can do after losing employer-subsidized coverage, about how to extend their COBRA coverage, or about how to buy a policy after having shopped around on a government exchange. Many don’t understand how to find out whether they qualify for an Affordable Care Act (a.k.a. “Obamacare”) premium subsidy. And I do my best to answer each and every question.

It’s scary to go without health insurance — that’s why I love helping people to obtain the coverage they need. So many people think they can’t afford it, but often they’re only thinking about the short-term expense and not considering the more serious, long-term financial and wellness implications of being caught without coverage when they need it most. Even a minor illness or injury, if left untreated due to lack of coverage, can progress into a serious or even life-threatening condition that one simply can’t ignore.

Take, for example, back pain that develops with a lifting or repetitive motion injury. Most often, back pain is attributable to a pulled muscle; over time, with rest, it should heal and resolve on its own. But in cases where a person has a bulging disc (or worse, a ruptured disc) pinching a nerve, leaving the problem untreated can lead to irreversible neurological damage, including the loss of bowel or bladder control, sexual dysfunction, or even paralysis.

Unfortunately, diagnosis of a ruptured or bulging disc requires an expensive magnetic resonance imaging (MRI) test, not to mention visits to an orthopaedist (bone doctor), and to a neurosurgeon, if surgery is necessary to prevent further nerve damage. For individuals without health insurance, these costs are prohibitive.

Visiting an emergency room likely won’t help; MRIs are rarely performed in ER settings and nothing can be done there to treat the underlying problem. Even pain relief can be difficult to obtain in the ER, with new state guidelines prohibiting the amount of chronic pain medications emergency doctors may prescribe.

You’re still going to need to see a specialist, and if you are self-pay, many of them will not see you without taking a cash deposit. Without proper health coverage, you could not only face bankruptcy, you could face a debilitating illness without access to proper care.

If you think about the long-term benefits of having proper coverage, they far outweigh any monthly bill. Moreover, an agent can help you maximize your benefit and minimize your out-of-pocket costs, and to match up policies available in your area to your unique medical and financial needs.

When a person approaches me and asks about obtaining health insurance, the first thing I generally do is listen to that person’s health and financial needs. Does he or she have any major, underlying illnesses or chronic conditions that require continuing checks? Does he or she see a variety of specialists? Are his or her doctors located across a wide geographic area or across several hospital systems, or are they all located in the same hospital-based physician group? Is monthly payment more of a concern, or are back-end costs like co-pays, co-insurance and deductibles what he or she wants to avoid? Does that person take several medicines on a regular basis? Are some of those medications still on patent and, thus, expensive? Is a provider notorious for a high amount of cost-shifting, red tape and rigmarole, or are claims easy to process?

For the average customer, calling around to various insurance companies, or sorting through confusing, hard-to-navigate websites to figure out whether or not all of one’s doctors are in-network can be time-consuming and intensely frustrating. As an agent, I have access to different areas of company websites and I can often find those answers more quickly. Moreover, my experience in health insurance sales has given me insights in how best to allocate coverage — I can help clients to avoid both under-coverage and overbuying.

I can also look at your financial situation and help you figure out quickly whether or not you are eligible for an Affordable Care Act subsidy, whether there is an exchange-based plan that meets your needs, or if there is an affordable, off-exchange option for you.

Lastly, an agent can be a great ally to have if you find yourself in a claims dispute with your insurance provider. I can go to bat for my clients and often successfully negotiate with an insurance provider to cover, or partially cover, a previously-denied claim. This takes savvy, a deep understanding of the system and rapport with underwriters and customer service managers, all of which have taken a long time to develop. I love being able to bring my knowledge of the process to bear in order to help my clients avoid a jam.

Even if you purchase on your own through an exchange, you can still designate an agent.  If going through the health insurance marketplace you can also give your agent permission to call on your behalf for up to 365 days – potentially saving you HOURS of frustrating phone calls.

If you do purchase an exchange-based policy, make sure you input your agent’s National Producer Number (NPN) on your application. Doing so allows your health plan to discuss the details of your coverage with your agent, so that we can help you obtain additional information from the plan provider when you have questions, or to negotiate on your behalf in a claims dispute. If you don’t designate an agent when buying your policy, you could find yourself going it alone and at your plan provider’s mercy.

If you haven’t started exploring your options yet, now is the time to do so. Log on to your state’s exchange and refresh your application from last year. Then, before you buy, talk to an agent and find out what on- and off-exchange plans are available in your area, how they compare to each other, how they compare to your needs based on cost and coverage, and whether or not all your doctors and medications are covered under those plans.

Don’t be caught without health insurance, or with the wrong policy, in 2015. There’s more than just a tax penalty at stake — your long-term health and financial stability are dependent upon having the right coverage, too. Find a health insurance agent and get started today!